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Critical Delays in HIV Testing and CareThe Potential Role of Stigma

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Abstract

When learning of a positive HIV test, individuals face a host of psychological and social stresses. HIV-related stigma is associated with psychological distress and can interfere with coping, adjustment, and management of HIV disease. Effective management of HIV disease requires timely testing for HIV infection so that persons who are infected can learn of their serostatus and gain access to care, therefore benefiting from available treatment options. This article discusses the impact that HIV-related stigma has on HIV testing and care. Specifically, problems associated with delays in testing, disclosure of seropositive status, and implications for health care are presented.
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... Not admitting it cost me a couple of years of my life in those six months. It is preferable to confront whatever occurs due to the disclosure; the internal conflict over disclosure can lead to loneliness, isolation and melancholy (Chesney andSmith, 1999, p. 1165;Nishanth et al., 2021). Infected people experience worries and irritation as a result of the secrecy. ...
... Specific risk groups, such as MSM, are particularly vulnerable to stigma. This, in turn, expresses the fear of being stigmatized simply for seeking HIV testing (Chesney andSmith, 1999, p. 1164). This means that certain groups bear the double sigma burden, which has a double impact. ...
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Purpose HIV or AIDS remains invisible and dismissed by most South Asians living in Canada as HIV or AIDS issues are perceived as an offshoot of Western lifestyle linked with drug use and promiscuity. This paper aims to look into how people living with HIV or AIDS (PLWHA) cope with prejudice and stigma. Design/methodology/approach To guide this research, a constructivist grounded theory approach was adopted as the theoretical and methodological framework. The authors reached the participants through a Toronto-based group that works with PLWHA. The authors chose their respondents in a snowball method and interviewed them both in person and online. Findings This paper identifies how South Asian immigrants and refugees/refugees with HIV or AIDS claimants are vulnerable to discrimination in Canada due to the following factors, which include but are not limited to: a lack of information about HIV and AIDS incidence in the community; and the Canadian health system's inability to respond appropriately to the lack of information. Practical implications HIV service engagements should take place within the context of a constellation of local traditions, or standardized expectations of patient engagement with HIV services can be counterproductive. Originality/value It is critical that governmental action prioritizes increasing public understanding of stigma. To minimize the consequences of HIV-related discrimination and stigma, misconceptions about HIV transmission must be debunked.
... mHealth platforms are promising tools that can change the HIV prevention landscape [43][44][45][46][47]. In countries where a hostile sociopolitical environment for MSM prevails, the ensuing stigma and discrimination around homosexuality hinder health care access and have been associated with reduced HIV prevention service uptake among MSM [48,49]. mHealth platforms are well placed to fill this gap, as they provide a web-based platform to deliver HIV services, especially in countries such as Malaysia where MSM are well connected to the internet and use smartphones to seek sexual health information on the web [29]. ...
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Background The use of smartphone apps can improve the HIV prevention cascade for key populations such as men who have sex with men (MSM). In Malaysia, where stigma and discrimination toward MSM are high, mobile health app-based strategies have the potential to open new frontiers for HIV prevention. However, little guidance is available to inform researchers about the ethical concerns that are unique to the development and implementation of app-based HIV prevention programs. Objective This study aimed to fill this gap by characterizing the attitudes and concerns of Malaysian MSM regarding HIV prevention mobile apps, particularly regarding the ethical aspects surrounding their use. Methods We conducted web-based focus group discussions with 23 MSM between August and September 2021. Using in-depth semistructured interviews, participants were asked about the risks and ethical issues they perceived to be associated with using mobile apps for HIV prevention. Each session was digitally recorded and transcribed. Transcripts were inductively coded using the Dedoose software (SocioCultural Research Consultants) and analyzed to identify and interpret emerging themes. Results Although participants were highly willing to use app-based strategies for HIV prevention, they raised several ethical concerns related to their use. Prominent concerns raised by participants included privacy and confidentiality concerns, including fear of third-party access to personal health information (eg, friends or family and government agencies), issues around personal health data storage and management, equity and equitable access, informed consent, and regulation. Conclusions The study’s findings highlight the role of ethical concerns related to the use of app-based HIV prevention programs. Given the ever-growing nature of such technological platforms that are intermixed with a complex ethical-legal landscape, mobile health platforms must be safe and secure to minimize unintended harm, safeguard user privacy and confidentiality, and obtain public trust and uptake.
... Çeşitli sağlık sorunlarına sahip bireylerin damgalanması, hasta haklarının korunmasında, hem makro hem de mezo düzeyde sürdürülebilirliğin sağlanmasında ön plana çıkan bir diğer sorundur. Damgalama, bireylerin kendi sağlık sorunlarını inkar etmesine (Chesney ve Smith, 1999), sağlık işçilerinin ayrımcı davranışlar göstermesine (Lauber vd., 2006) ve/veya toplumsal dışlanmaya (Bauman, 2007) neden olarak insan haklarını ve tabii ki hasta haklarını baskılayan bir süreçtir. Örneğin, zihinsel ya da psikolojik sorunları olan (Schachter vd., 2008;Wallace, 2012), cinsel yolla bulaşan hastalıklara sahip olan (Özakgül vd., 2014) ya da bedensel görünüme çeşitli şekillerde yansıyan hastalıklara sahip olan bireylerin (Yu vd., 2015) bu türden damgalamalar nedeni ile çeşitli düzeylerde ve şekillerde ayrımcılığa maruz kalabileceği açıktır. ...
... PLWH who experience more stigmatizing interactions regarding their illness experience higher levels of psychosocial distress (Hutton et al., 2013;Song & Ingram, 2002). Widely held sentiments about the marginalized status of PLWH create obstacles to the provision of efficient medical care and compassionate psychosocial support (Chesney & Smith, 1999). HIV stigma stems from the infection's association with behaviors such as injection drug use, homosexuality, and sex work, all of which have historically been deemed to be immoral or illicit in South Asian contexts Ghose et al., 2008). ...
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The goal of this study was to explore the association between HIV stigma and depression and whether gender moderated this relationship. The theoretical framework for the study combined an adapted version of Goffman's conceptualization of stigma with gender role theory. We surveyed 150 individuals living with HIV in Hyderabad, India (51 cisgender women, 49 cisgender men, and 50 third gender people) on their experiences with HIV stigma. While third gender people had statistically higher scores for HIV stigma over their cisgender counterparts, the association between each of three different forms of stigma (internalized stigma, perceived stigma, and experienced stigma) on depression was negatively moderated by third gender status. This demonstrates that third gender research participants who experienced certain forms of HIV stigma were less likely to be depressed than cisgender participants. These findings indicate resilience amongst third gender people living with HIV and can be used to better tailor social policies and gender‐affirming HIV care programs in south India.
... In particular, the uptake of HIV testing services remains low in key populations, resulting from structural issues that limit access and fear of stigmatisation and breach of confidentiality [7]. Discriminatory attitudes towards PLHIV persist and negatively impact the use of HIV services [8]. Further, the fear of HIV-related stigma has led to PLHIV avoiding disclosure of HIV status and delaying or staying in treatment [9]. ...
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Article
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In early 2020, the first wave of the COVID-19 pandemic hit India, generating one of the highest rates of infection and death in the world. Meanwhile, healthcare workers experienced stigma and discrimination due to their association with COVID-19 patients. This study analyzed healthcare workers’ experience of courtesy stigma in India, the communication strategies they used to manage stigma, and the impact on their mental health. A cross-sectional survey of 150 healthcare workers in India showed that almost 50% experienced discrimination due to their association with COVID-19 patients. Using Confirmatory Factor Analysis and Structural Equation Modeling, this study found that experience of discrimination was associated with perceived courtesy stigma. Two stigma management strategies (reducing offensiveness and passive acceptance) mediated the relationship between perceived courtesy stigma and perceived stress and depression. Participants also reported engaging in stigma management strategies of bonding with other healthcare professionals and passive acceptance of the stigma more than reducing stigma and displaying/disclosing stigma. We conclude that perhaps due to depletion of cognitive and emotional resources, healthcare workers engaged more in social support (bonding) and passive stigma acceptance strategies to alleviate the stress associated with providing COVID-19 patient care. Practical and theoretical implications are further discussed.
Chapter
Structural racism is a fundamental cause of health disparities in the United States among racial/ethnic and sexual/gender minorities. Although there are well-documented disparities in the access of HIV prevention, care, and treatment services, the impact of structural racism on HIV/AIDS remains not well understood. The purpose of this chapter is to provide a detailed description of (1) the theoretical underpinnings of the link between structural racism and HIV, (2) a review of the evidence of these associations, and (3) a culturally appropriate, trauma-informed agenda that addresses intersectional, multi-level structural racism and its myriad manifestations to reduce HIV vulnerability for racial/ethnic and sexual/gender minorities, particularly Black sexual minority men.
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This article describes the importance of stigma to understanding the experience of becoming infected with the human immunodeficiency virus (HIV), especially with respect to social relationships. Based on anonymous questionnaires from respondents who either have AIDS, AIDS-related complex or are infected but asymptomatic, we found that many of those infected with HIV do not feel stigmatized or show its effects. Those who do feel stigmatized also felt anxious, depressed and alienated from others. These feelings of anxiety, depression and alienation were independent of HIV diagnostic severity but were associated with disruptions in normal social relationships.
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Since January 1990, human immunodeficiency virus (HIV)-infected patients attending two sexually transmitted disease clinics in Baltimore, Md, have been offered T-lymphocyte subset evaluations. From January through September, CD4+ lymphocyte concentrations were measured in 223 newly diagnosed HIV-infected patients; 50% had fewer than 500 CD4+ T cells and 12% had fewer than 200 CD4+ T cells per cubic millimeter. Most patients were asymptomatic, and, even among patients with fewer than 200 CD4+ T cells, 54% had no symptoms or signs suggestive of advanced HIV infection. Homosexually active men had significantly lower mean CD4+ lymphocyte concentrations than intravenous drug users. Given the substantial numbers of patients with CD4+ concentrations that qualified them for zidovudine therapy, we also assessed their mechanisms of paying for health care. Only 24% of HIV-infected patients had private insurance. Seventy-two percent of patients with fewer than 200 CD4+ T cells either had no insurance or relied on public assistance for health care. Thus, although 50% of asymptomatic individuals identified by routine voluntary HIV screening in an inner-city sexually transmitted disease clinic may benefit from therapy for their disease, 75% of those qualifying for presently recommended therapy either depend on publicly funded health care or have no means of payment for care. (JAMA. 1991;266:253-256)
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